Sto najbardziej wpływowych osób w polskiej ochronie zdrowia

dniu 7 lutego br. odbyła się uroczystość ogłoszeniawyników i wręczenia dyplomów laureatom X konkursu PulsuMedycyny, tzw. „Listy stu”

Landscape of oncoplastic breast surgery across Poland

Techniki onkoplastyczne i rekonstrukcyjne stanowią podstawowe narzędzia pracy współczesnych chirurgów piersi. Celem badania było ustalenie rodzajów rekonstrukcji onkoplastycznych przeprowadzanych w ośrodkach leczenia raka piersi w Polsce. Drogą e-mailową rozesłano kwestionariusz zawierający 18 pytań do członków Polskiego Towarzystwa Chirurgii Onkologicznej oraz Polskiego Towarzystwa Chirurgii Plastycznej, Rekonstrukcyjnej i Estetycznej poprzez ich portale internetowe. Liczba pacjentek z rakiem piersi poddawana operacji sięgała od 120 do 904 rocznie w każdym z ośrodków. Wykonywano głównie operacje oszczędzające pierś (breast conserving surgery - BCS) z wyjątkiem jednego ośrodka (zakres 50 – 70%). Jednoczasową rekonstrukcję piersi (immediate breast reconstruction - IBR) wykonywano w 6-42% zabiegów. Najczęstszym rodzajem IBR była dwuetapowa rekonstrukcja z użyciem ekspandera i wszczepieniem implantu lub jednoetapowa rekonstrukcja przy użyciu implantu z lub bez wszczepienia siatki syntetycznej. Najczęściej wykonywanym zabiegiem odroczonej rekonstrukcji piersi (delayed breast reconstruction - DBR) była dwuetapowa rekonstrukcja z użyciem ekspandera i następnie z wszczepieniem implantu. W żadnym z badanych ośrodków nie wykonywano rekonstrukcji z użyciem wolnego płata. W ośrodku chirurgii plastycznej wykonywano rekonstrukcję z wykorzystaniem płata perforatorów głębokich naczyń nabrzusznych dolnych (DIEP). W ośrodkach onkologicznych wykonywano rekonstrukcje z użyciem płatów uszypułowanych. W wybranych ośrodkach stosowano bezkomórkowe macierze skórne (ADM) oraz przeszczep tkanki tłuszczowej. Oceniono wyniki na podstawie opinii pacjentów (patient-reported outcome measures - PROM) oraz powikłania po zabiegach. Nasze wyniki mogą stanowić podstawę do dalszego doskonalenia umiejętności, akredytacji, zbierania danych i audytu, w tym oceny na podstawie opinii pacjentów. Istnieje również pilna potrzeba rozwiązania problemu nierówności w refundacji procedur w różnych państwach Europy.Oncoplastic and reconstructive techniques are essential tools in the armamentarium of contemporary breast surgeons. The aim of the study was to identify oncoplastic reconstructive patterns in breast cancer centers across Poland. A questionnaire of 18 questions was sent by email to the members of the Polish Society of Surgical Oncology and the Polish Society of Plastic, Reconstructive and Esthetic Surgery via their dedicated websites. The numbers of breast cancer patients operated on in each center ranged from 120 to 904 per year. Breast-conserving surgery (BCS) predominated in all but one center (range 50-70%). Immediate breast reconstructions (IBR) accounted for 6-42% of procedures, The most frequent type of IBR was either a two-stage expander followed by a permanent implant or one-stage implant- based with or without synthetic mesh. The most frequent type of delayed breast reconstruction (DBR) was a two-stage expander followed by implant-based reconstruction. None of the surveyed cancer centers performed free flap reconstruction. Deep inferior epigastric perforator (DIEP) flaps were performed in the plastic surgery department. Reconstructions based on pedicled flaps were performed in cancer centers. Acellular dermal matrices (ADM) and fat transfer were used in selected centers. In the clinical scenario of adjuvant radiotherapy, delayed breast reconstruction was favored. The full range of oncoplastic BCS was performed. Patient-reported outcome measures (PROM) and complications were assessed. Our findings can act as a platform for further improvement in skills, certification, data collection and audit, including patient reported expectation measures. There is also an urgent need to address pan-European inconsistencies in procedural reimbursement

Results of the treatment of patients with solid tumours and liver metastases: 8 years experience of one institution

Wstęp. Leczenie chirurgiczne przerzutów nowotworów litych do wątroby powinno odbywać się w ramach zespołu wielodyscyplinarnego.Cel pracy. Celem pracy jest ocena wyników leczenia skojarzonego chorych na różne nowotwory lite z przerzutami do wątroby przez zespół wielodyscyplinarny jednego ośrodka onkologicznego w ciągu ostatnich 8 lat.Materiał i metody. Retrospektywną analizą objęto 166 chorych (84 kobiety i 82 mężczyzn) w wieku od 19 do 78 lat (średnia 58 ± 11,2), leczonych z powodu przerzutów do wątroby pierwotnych nowotworów litych o różnej lokalizacji, z wyjątkiem guzów neuroendokrynnych. Każdorazowo rozważano okołooperacyjne leczenie systemowe zgodnie z aktualnymi zaleceniami Polskiej Unii Onkologii.Wyniki. W czasie obserwacji (mediana 35 miesięcy) zmarło 46% chorych. Resekcje wątroby wykonano u 107 (65%)chorych, w tym u 19 chorych połączono je z (RF-)termoablacją zmian przerzutowych, którą wykonano jako samodzielny zabieg u dalszych 59 (36%) chorych. Śmiertelność pooperacyjna wyniosła 1,2%. Powikłania II° wg klasyfikacji Clavien-Dindo wystąpiły u 33 (19,8%) chorych, natomiast III° i IV° — u 8 (4,8%) chorych. Przeżycia 1-roczne, 3-letniei 5-letnie wyniosły odpowiednio 78%, 41% i 37%. Pięcioletnie przeżycia całkowite u chorych na raka jelita grubego po resekcjach przerzutów metachronicznych wyniosły 48%.Wnioski. Skojarzone leczenie chorych na nieendokrynne nowotwory lite z przerzutami do wątroby przez zespół wielodyscyplinarny jest bezpieczne i skuteczne. W starannie dobranej grupie chorych można osiągnąć blisko 50% całkowitych przeżyć 5-letnich. Resekcja wątroby jest optymalną metodą leczenia chirurgicznego przerzutów do wątroby.Introduction. Surgical treatment of liver metastases from solid tumours should be provided by multidisciplinary teams.Aim. The aim of the present study is to analyse results of the combined treatment of patients with different solid tumours and liver metastases by single institution multidisciplinary team for last 8 years.Material and methods. This is a retrospective analysis of 166 patients (84 females and 82 males), aged from 19 to 78 years (mean 58 ± 11.2), treated due to liver metastases from solid tumours in various primary localizations: except neuroendocrine tumours. In every patient, perioperative systemic therapy was evaluated in agreement with current recommendations of the Polish Union of Oncology.Results. In the follow-up time available (median 35 months) 46% of patients died. Liver resections were performed in 107 (65%) patients, including 19 patients in whom resections were supplemented with (RF-)thermoablations of their liver metastases. This was the sole surgical treatment in the 59 (36%) patients. Perioperative mortality was 1.2%. Grade II complications according to the Clavien-Dindo classification were found in 33 (19.8%) patients, whereas grade III and IV complications were treated in 8 (4.8%) patients. One-, 3-, and 5-year survival rates were respectively 78%, 41%, and 37%. Five-year overall survival in patients with colorectal carcinoma after liver resection of metachronous metastases was 48%. We conclude that combined treatment of patients with liver metastases from non-endocrine solid tumours by the multidisciplinary team is safe and effective. A nearly 50% 5-year survival is achievable in a carefully selected group of patients. We also conclude that hepatic resection is an optimal method of surgical treatment of liver metastases

Imaging methods for the local lymphatic system of the axilla in early breast cancer in patients qualified for sentinel lymph node biopsy

Breast cancer is the most common malignancy in women in well-developed countries. Despite a constant increase in its incidence, the percentage of patients diagnosed with the disease in the non-invasive stage is also rising. This allows more frequently for the use of breast-preserving surgical techniques, involving the breast and the regional lymphatic system. According to current guidelines of expert panels and research societies, the recommended method of identifying the sentinel lymph node is the use of an isotope marker with a dye (a combined isotope and dye method). Cooperation with a nuclear medicine unit is essential (performing a preoperative lymphoscintigraphic scan to identify the lymphatic drainage basin and sentinel lymph node). In the case of smaller centers treating breast cancer, it can be associated with a number of difficulties, including organizational ones, and also increasing general treatment costs. A possible solution to these problems is to use alternative techniques of visualizing the sentinel lymph node, which do not require a radiotracer. In this paper we discuss the currently available methods of mapping the lymphatic system of the axillary region in patients with early breast cancer. The review is limited to reporting on methods of proven (based on clinical research) high diagnostic value

Intraoperative radiotherapy with low energy photons in recurrent colorectal cancer: a single centre retrospective study

Aim of the study: Intraoperative radiotherapy (IORT) may improve outcome of surgical treatment of recurrent colorectal cancer (CRC). The aim of this study is to determine the feasibility, safety and long-term results of surgical treatment of recurrent CRC with orthovolt IORT. Material and methods: Fifty-nine consecutive CRC patients with local recurrence (LR), undergoing surgery, were included in the retrospective analysis of prospectively collected data. The modified Wanebo classification was used to stage LR (Tr). Twenty-five (43%) patients received IORT using INTRABEAM® PRS 500. The complications were classified according to the Clavien-Dindo classification. Results: There were 32 males and 27 females, with a median age of 63 years. Multi-visceral resections were performed in 37 (63%) patients. Median hospitalization time after surgery with IORT was 7 days. One (1.7%) in-hospital postoperative death was reported. Grade 3/4 postoperative complications were found in 11 (19%) patients. Intraoperative radiotherapy had no effect on the postoperative hospitalization time, morbidity and mortality. Median survival after R0 resection was 32 months. Complete resection (R0), no synchronous liver metastases (M0), and no lateral and posterior pelvic wall involvement, were significant predictors of improved survival. Stage of LR was found to be an independent prognostic factor in the multivariate analysis (p = 0.03); Cox regression model). In patients with LR stage < Tr5, a 3-year overall survival (OS) rate was 52%. Conclusions : Combination of surgical resection and orthovolt IORT is a safe and feasible procedure that does not increase the risk of postoperative complications or prolongs the hospital stay. Despite aggressive surgery supported by IORT, the advanced stage of LR is a limiting factor of long-term survival

Superparamagnetic Iron Oxide for Identifying Sentinel Lymph Node in Breast Cancer after Neoadjuvant Chemotherapy: Feasibility Study

Sentinel lymph node biopsy (SLNB) is a well-established procedure for staging clinically node-negative early breast cancer (BC). Superparamagnetic iron oxide (SPIO) demonstrated efficacy for nodal identification using a magnetic probe after local retroaeroal interstitial injection. Its benefits lie in its flexibility, which is an essential property in the global setting, where access to the isotope is difficult. To the best of our knowledge, this is the first study to evaluate the feasibility and safety of the SPIO for SLNB in BC patients treated with neoadjuvant chemotherapy (NAC). Seventy-four female patients were included. The median time of lymph node retrieval was 20 min. The median number of resected sentinel nodes (SNs) was 4. SN was detected in all patients. No serious adverse event was observed. SPIO in identifying SN in BC patients after NAC is feasible and oncologically safe

Prognostic value of p27kip1 expression in adenocarcinoma of the pancreatic head region

Background. p27kip1 is a tumour suppressor gene, functioning as a cyclin-dependent kinase inhibitor, and an independent prognostic factor in breast, colon, and prostate adenocarcinomas. Conflicting data are reported for adenocarcinoma of the pancreas. The aim of this study was to establish the prognostic value of p27kip1 expression in adenocarcinoma of the pancreatic head region. Patients and methods. The study included 45 patients (male/female ratio 2:1; mean age 59, range 38–82 years) with adenocarcinomas of the pancreatic head region: 24 – pancreatic head, 18 – periampullary and 3 – uncinate process. The patients underwent the Kausch-Whipple pancreatoduodenectomy (n=39), pylorus-preserving pancreatoduodenectomy (n=5), or nearly total pancreatectomy (n=1). Eight patients received adjuvant chemotherapy postoperatively. Follow-up time ranged from 3 to 60 months. Tumours were staged according to the pTNM classification (UICC 1997). Immunohistochemistry was done on paraffin-embedded blocks from tumour sections. Quantitative determination of p27kip1 expression was based on the proportion of p27kip1 -positive cells (< 5% = negative). Survival analysis was carried out using the Kaplan-Meier method and Cox regression model. Results. Positive p27kip1 expression was detected in 22 tumours (49%), whereas 23 tumours (51%) were p27kip1-negative. There were no significant correlations between p27kip1 index and stage or lymph node involvement. Median survival time in patients with p27kip1-positive tumours was 19 months, whereas in patients with p27kip1-negative tumours it was 18 months (p=0.53). A significant relationship was found between p27kip1-negative tumours and radical resection (p=0.04). Multivariate survival analysis revealed that the localization of the tumour (pancreatic head/uncinate process vs periampullary) was the only significant and independent prognosticator (p = 0.01, Cox regression model). Resection margins involvement and grade remained nearly significant prognostic factors (p=0.07 and p=0.09, respectively). Conclusion. We conclude that p27kip1 has limited overall prognostic utility in resected carcinoma of the pancreatic head region, but its potential role as a marker of residual disease needs to be further assessed

A Propensity Score Matched Analysis of Superparamagnetic Iron Oxide versus Radioisotope Sentinel Node Biopsy in Breast Cancer Patients after Neoadjuvant Chemotherapy

The standard method for nodal staging in breast cancer (BC) patients after neoadjuvant chemotherapy (NAC) is sentinel lymph node biopsy (SLNB) with a radioisotope (RI) injection. However, SLNB after NAC results in high false-negative rates (FNR), and the RI method is restricted by nuclear medicine unit dependency. These limitations resulted in the development of the superparamagnetic iron oxide (SPIO) method, reducing FNR and presenting a comparable detection rate. This bi-institutional cohort comparison study aimed to assess the efficacy of SPIO and radioisotope SNLB in BC patients after NAC using Propensity Score Matching (PSM) analysis. The study group comprised 508 patients who underwent SLNB after NAC for ycT1-4N0M0 BC between 2013 and 2021 in two high volume centers. Data were retrieved from prospectively conducted databases. In the SPIO group, the median of retrieved sentinel lymph nodes (SLNs) was significantly higher than in the RI group (3 vs. 2; p &lt; 0.0001). The SPIO method was associated with a significantly higher chance of retrieving at least three lymph nodes when compared to the RI method (71% vs. 11.3%; p &lt; 0.0001). None of the analyzed demographic and clinical variables had a statistically significant influence on the efficacy of SLNs retrieval in the RI group, while in the SPIO group, patients with &ge;three harvested SLNs had lower weight and decreased BMI. Based on this PSM analysis, SPIO-guided SLNB allowed the efficient retrieval and detection of SLNs in BC patients after NAC compared to RI